Prostate Adenocarcinoma

Background: Prostate adenocarcinoma is the most common malignancy in men in Italy, with generally favorable survival rates when detected early. Despite multiple treatment options, disease recurrence remains a clinical challenge. Case Presentation: Reported the case of a 78-year-old male with recurrent prostate adenocarcinoma initially diagnosed in 2009 (PSA 29 ng/mL). The patient underwent treatment with Casodex followed by external beam radiotherapy (62 Gy in 2010). Subsequent follow-up revealed biochemical recurrence and multiple local recurrences confirmed on PET/CT imaging. Over the years, the patient received androgen deprivation therapy (Enantone), anti-androgens (Casodex, Enzalutamide), and repeat imaging demonstrated progression with prostate and seminal vesicle involvement. Investigations: Serial PSA monitoring, multiparametric imaging (PET/CT with 18F-Choline, PSMA PET), and CT scans of thorax and abdomen identified recurrent lesions in the prostate, ribs, and lymph nodes, as well as coexisting renal and bladder changes. Management and Outcome: The patient was managed with hormonal therapy and radiotherapy, with intermittent biochemical control. In 2025, PET findings indicated persistent disease activity, and the patient was scheduled for re-irradiation with radiotherapy in July 2025. Conclusion: This case highlights the complexity of managing recurrent prostate adenocarcinoma after definitive therapy. Multimodality imaging and individualized treatment strategies remain crucial for long-term disease control in elderly patients.